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Cambia Health Solutions · 9 hours ago

Policy & Implementation Analyst

Beaverton, OR

Full-time

Hybrid

Mid Level

$64K/yr - $106K/yr

3+ years exp

Cambia Health Solutions is focused on creating a person-focused and economically sustainable health care system. The Policy & Implementation Analyst will evaluate, recommend, and implement clinical editing solutions to ensure accurate outcomes consistent with medical policies, while developing and executing implementation plans.

BiotechnologyHealth CareInformation Technology

Responsibilities

Facilitates development, understanding and documentation of business requirements related to policy implementation and clinical editing

Performs analysis in the design and implementation plans to support new and revised medical and reimbursement policies

Responsible for maintaining online documentation for accurate and uniform administration of medical and reimbursement policy

Coordinates the implementation of new and revised online reference materials and technical documentation

Communicates policy and edit decisions to internal and external customers in a clear and concise manner

Qualification

Medical coding knowledgeClaims processingCPC CertificationAnalytical skillsReimbursement policiesCommunication skillsTeam collaborationProblem-solving skills

Required

Bachelor's degree in Business Administration or a related field 3 years of experience in a healthcare related environment utilizing analytical skills or an equivalent combination of education and experience

Current licensure or professional certification relevant to the work (RN or coding certification) is preferred

Understanding of claims processing to evaluate implementation needs

Demonstrated analytical ability to identify problems, develop solutions and implement a chosen course of action

Ability to present issues, lead and/or participate in discussions and develop conclusions with internal and external medical professionals and other experts

Demonstrated knowledge of the following: CMS reimbursement and medical policies; Medicare products; Procedural and diagnostic coding; and the national Resource Based Relative Value Schedule

Serves as primary support for CPT/HCPCS procedure and ICD-9/ICD-10 diagnosis coding questions across Cambia, ensuring decision-making related to coding is consistent, clinically appropriate and thoroughly documented

Applies coding expertise and judgment to assure medically appropriate and accurate claims adjudication

Preferred

Clinical knowledge (Understands clinical reviews)

Understanding of claims, billing and coding

Facets/claims systems in appeals, SIU

Claims processing, claims configuration roles

Understanding of Medical and reimbursement policies

CPC Certified or willing to get CPC Certified as condition to position

Benefits

Medical, dental and vision coverage for employees and their eligible family members, including mental health benefits.

Annual employer contribution to a health savings account.

Generous paid time off varying by role and tenure in addition to 10 company-paid holidays.

Market-leading retirement plan including a company match on employee 401(k) contributions, with a potential discretionary contribution based on company performance (no vesting period).

Up to 12 weeks of paid parental time off (eligibility requires 12 months of continuous service with Cambia immediately preceding leave).

Award-winning wellness programs that reward you for participation.

Employee Assistance Fund for those in need.

Commute and parking benefits.